Called cardiac calcium scoring, the test uses a special x-ray called a CT scan to show the location and extent of calcified plaque in a person's coronary arteries. "Calcium does not deposit in healthy arteries; it deposits in arteries which already have plaque," says Dr. Mike Mounir, a Lafayette cardiologist. "This new technology is making it very easy for us to know if someone is starting to have atherosclerosis [fatty material deposited along the walls of the arteries]. I use this technology to know how aggressive I need to be in treating different patients."
The coronary arteries are the vessels that carry blood to the heart wall. The main cause of heart disease is build-up of plaque, which includes fat and calcium, in the arteries of the heart. When the arteries narrow, the heart muscle doesn't get enough oxygen-containing blood, and a heart attack can occur. The plaque can also break away from the artery walls and cause blockage.
Available in this market for several years, this calcium scoring test is non-invasive, uses no dye or needles and exposes a patient to minimal radiation.
The CT's sub-second scanning capability takes 70 to 90 images of the patient's coronary arteries to derive a calcium score. The entire process takes less than 10 minutes. A fully clothed patient simply lies down on the table attached to the CT scanner while a technologist places a few EKG leads on his chest. The table slides through the opening in the scanner while a cylinder around the opening rotates around his body, and the electrodes ' which are also attached to a machine that records the electrical activity of the heart ' make it possible to record CT scans when the heart is not actively contracting. The patient holds his breath for periods of 20 to 30 seconds while the images are recorded ' and the test is over.
Radiologists like Dr. Henry McLemore of the Acadiana Radiology Group at Our Lady of Lourdes read the results using high tech software that shows the cross-sections, or slices, of the areas of interest and calculate the calcium score. They provide an evaluation within 48 hours.
"We've had some people that took the test and they had calcium, so we checked the other risk factors," McLemore says. "If they'd have kept on, they might have had a heart attack and required more extensive surgery than just a stent."
"The test is most beneficial in middle-aged people, 45 to 50 and above, because young people could have plaques and blockage without calcium deposit," Mounir says. The test also does not detect soft plaque, the earliest form of coronary artery disease.
"If the calcium score is zero in a middle-aged person, that means this person has a 95 percent chance of not having any blockages," the cardiologist continues. While zero means no buildup, a score above 400 indicates significant buildup and plaque ' most likely obstruction of one of the coronary arteries. "If a calcium score is high, that means indirectly that the plaque burden is high also."
The calcium scoring test doesn't indicate if the plaque is obstructive, but a score in the 1,000 to 2,000 range is a likely sign of obstruction, and the patient typically will undergo coronary angiography. This invasive procedure is more risky and much more expensive. Considered the "gold standard" for detecting coronary artery stenosis (the narrowing or obstruction of the heart's aortic valve), it uses dye injected through a thin catheter in the groin or arm to enhance x-ray images of the heart. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart. The pictures that are obtained are called angiograms, and the physician is able to correct problems during the procedure.
If a person's calcium score is between 100 and 400, other factors must be weighed before additional tests are ordered. "If he does not have chest pain or an abnormal stress test, then he does not need to have any further testing, just starting him on cholesterol medication and aspirin," Mounir says. If the patient is having some chest discomfort and the stress test is inconclusive, the physician may recommend a cardiac CT angiogram, which uses the same calcium scoring CT technology but includes a dye contrast administered intravenously in the arm.
Though vastly improved in terms of the number of slices it produces in a single rotation to create a 3-D image of the heart, cardiac CT angiography still is not sufficient to replace the traditional catheter-based coronary angiography, Mounir says. For example, he says it doesn't produce clear images in an overweight person.
If the calcium scoring reveals a high chance of having heart disease, a person should also take steps such as eating better, quitting smoking and getting more exercise ' lifestyle adjustments similar to those a doctor would recommend after looking at a person's health history, physical health, and any lab tests, such as a cholesterol test.
McLemore has personally undergone the test twice, the second revealing a calcium score of 19 (only a minimal risk), so he simply increased his exercise regimen and continued taking a mild medication for his elevated cholesterol.
The struggle to fight America's No. 1 killer is far from over, but Lafayette's medical community believes early diagnosis through this revolutionary and affordable CT imaging is going a long way toward better managing the crisis. "It not only detects calcium in the arteries; I have seen enlarged hearts, pericardial effusions [fluid around the heart], calcification of the heart valve and evaluations of the aorta," says McLemore. "It's a screening test, but you get a good idea of what the heart and everything else [around it] looks like."
McLemore, however, cautions against leaning on a single test for determining a person's chances of developing coronary artery disease. He says all other risk factors ' high cholesterol, high blood pressure, smoking and diabetes ' must be weighed. "This is a screening test. It should not take the place of a physical exam for detection of your risk factors," the doctor says.
For now in Lafayette a physician has to request the test, but Mounir believes that may soon change ' it has in other states. "I do expect in the future it could be done without a physician order," he says. Mounir's only fear is the test could lead to unnecessary procedures, meaning a higher number of coronary angiograms. "That is why it should be done with the knowledge of a physician who will interpret the test according to the whole clinical picture," he says.
Casual cool for Thanksgiving
Shop Lafayette goes strong
The fight to clean up Lafayette Parish could get some added ammunition with two ordinances up for votes Tuesday by the City-Parish Council targeting litter-bugs.
A divided 3rd Circuit Court of Appeal reversed a Lafayette district judge’s ruling absolving the co-owner of a New Iberia accounting firm of liability in an embezzlement case.
Our View: It’s reasonable, temporary and invests in Lafayette’s future.
Acadiana's nightlife guide.
By striking a deal to lessen the blow of health insurance changes on state workers, school employees and retirees, Gov. Bobby Jindal's administration lowered the volume of criticism but gave itself and local school boards a new budget headache.
With the airport tax coming up for a parishwide vote in about a week, the Broussard City Council and its mayor have come out in support of the proposal.
Protesters rallied peacefully in several Louisiana cities in the wake of the Missouri grand jury decision not to indict a police officer in the fatal shooting of Michal Brown.
Three bedroom in Port Barre or two bedroom in Opelousas
US cities bidding on Olympics; Guard prevents more Ferguson riots; storm threatens travel and more national and international news for Wednesday, November 26, 2014.
Wednesday's Blogs from the Bog!
The U.S. rep billed LSU for work allegedly performed on the same days Congress voted on major legislation and held important committee hearings on energy and the ACA.
“I am only getting a little nervous about two projects — the proposed Sasol GTL facility [not the new ethylene plant] and the proposed G2X facility — both in Lake Charles. They need a hefty difference between oil and natural gas prices to make sense.”
Abysmally low participation by the public has prompted the council to scuttle the 2014 survey with plans to simplify it and try again next year.
The village now says the ordinance will likely be overturned and authorities will more vigorously enforce existing leash laws.
Lower oil prices also might slow the growth of oil production in parts of the U.S., Canada and elsewhere because it will no longer be so profitable.
Bill Cassidy cast an early ballot Tuesday, seeking to draw renewed attention to a race that has fallen off newspaper front pages and away from people's minds as they plan holiday meals and shopping schedules.
A Lafayette woman faces up to 20 years in prison for running up more than $1 million in unauthorized charges to her company credit card.
Signs that our state’s banking industry is undergoing a downsizing in 2014 were further confirmed today with the FDIC’s latest figures showing a third straight quarter in which Louisiana lost more banks and earned less money.
Acadiana's nightlife guide.
State police say a 47-year-old Lafayette man, who collected more than $83,000 in disability benefits, is accused of operating two businesses out of his home at a time when he claimed he had no income.
Battered all night by Baltimore's relentless pass rush, Drew Brees could feel his protection collapsing and Terrell Suggs getting ahold of him as he urgently unloaded a pass to the right flat toward tight end Jimmy Graham.
After a convincing defeat at the polls on Nov. 4, Earl “Nickey” Picard has decided to let bygones be bygones with his former right-hand man Brian Pope, announcing his support for his former employee’s runoff bid to become Lafayette’s next city marshal.
Saturday the athletic department did everything possible to ensure the 2014 Ragin’ Cajun seniors remembered fondly their last home game. Rain and lightning never arrived but turbulence did in the form of the Appalachian State Mountaineers.
Even stranger than the Republican Party’s decision to hold a “unity rally” earlier this month for Congressman Bill Cassidy in a Baton Rouge bar, Huey’s Bar, was the fact that the establishment was named after Louisiana’s most famous Democrat.
Bar Code is not a gay bar.
After failing to pass a medical marijuana bill last year, state Sen. Fred Mills, R-Parks, is telling supporters he will return in 2015 with legislation that focuses on different applications like oils and pills.
Voters, obviously, are not yet tuned into the 2015 ballot, despite the intriguing races it will host.
Acadiana's nightlife guide.